Engaging Physicians to Achieve Both Margin and Mission

摘要

One of the many challenges that healthcare organizations face is the complex and fragmented reimbursement landscape. Broadly speaking, payment comes either from government contracts such as Medicare and Medicaid or from commercial insurance contracts that have paid on a fee-for-service basis. This model has become unsustainable, and carriers are looking at alternative methodologies, including capitation and value-based payments. Medicare, for example, pays a hospital a fixed fee based on the patients diagnosis-related group. If the cost of care is less than that payment, the service is profitable; if the cost is more than that payment (as is frequently the case), the service is not profitable.